Medicine-Renal Flashcards
(119 cards)
1
Q
Classic Presentation for [Renal Cell Carcinoma] (4)
A
RCC looks like HAWF!
[Hematuria PAINLESS (most common)] / [Abd palpable Mass] / [Wt loss] / [Flank Pain]
Scrotal varicoceles are in 10% of pts
L RCC in image
2
Q
Normal range for PCO2
A
33 - 44 (40 = standard)
3
Q
List the indications for HemoDialysis - 5
A
AEIOU
Acidosis (HCO3 <10, pH<7.1)
Electrolytes (⇪K>6.5 / Mg / P) or (⬇︎ Ca+)
Intoxication (Alcohols/ASA/Lithium/Anticonvulsants)
Overloaded BADLY with Fluid
Uremia (⇪ NH3-BUN)
4
Q
What causes Sundowning?-3
Describe Sundowning
Tx?
A
[Alzheimers vs. EtOH withdrawal vs. Delirium] –> Circadian Rhythm dysfunction –> [⬆︎confusion & agitation at Sundown]
Tx = Melatonin
5
Q
It takes Lungs minutes to compensate for acidosis/alkalosis
How long does it take Kidneys to compensate for respiratory acid-base
A
2 days
6
Q
What are the 2 main electrolyte SE of Furosemide? ; how do they affect the heart?
A
- hypOkalemia which can –>VTach!
- hypOmagnesemia which can –>VTach!
High doses of Loop diuretics also cause reversible or permanent hearing loss and/or tinnitus
7
Q
ADPKD - [Autosomal Dominant Polycystic Kidney Dz]
Describe the Disease - 7
A
ADPKD
Aneurysm (Berry)
Doomed [HTN and MVP]
[PrOteinuria AND Hematuria]
Kidney Failure (Early vs. Late onset) - Hepatomegaly occurs if cystic involvement
Differentation problem = Etx
Image: Renal Ultrasound which = Dx
8
Q
BUN Normal range
A
7- 18
9
Q
5 main serum electrolyte changes due to Chronic Kidney Dz
A
- ⬆︎ K+
- ⬆︎Phosphate
- ⬆︎H+
- ⬆︎ Mg
- DEC Ca+
10
Q
How does Ethylene Glycol affect Kidneys?
A
EG is converted into oxalate by liver –> binds to Ca+ = retangular envelope shaped Ca+Oxalate crystals –> Tubular damage
11
Q
Fomepizole MOA and indication
A
Inhibits [Hepatic Alcohol Dehydrogenase] from converting Ethylene Glycol into oxalate ; EG poisoning
12
Q
What agents induce Renal dysfunction via Afferent Arteriole vasoconstriction-5
A
- NSAIDs
- Amphotericin B
- Cyclosporine
- Tacrolimus
- Radiocontrast (also causes oxidant injury)
13
Q
Identify the type of cast and associated Disease
A
Muddy Brown Granular Cast = Acute Tubular Necrosis
14
Q
Identify the type of cast and associated Disease
A
RBC Cast = Acute Glomerulonephritis
15
Q
Identify the type of cast ; what 2 Disease is it associated with?
A
WBC Cast = ATiiN (Acute Tubular interstitial nephritis) or Pyelonephritis
16
Q
Name 4 classes of drugs to cause Fever
A
- Anticonvulsants (via Hypersensitivity syndrome)
- Abx
- Anticholinergics
- Sympathomimetic
17
Q
Hepatorenal syndrome Etx
A
Portal HTN from liver failure –> MASSIVE Splenic ARTERIAL Vasodilation –> ⬇︎BP –> PreRenal AKI that’s NOT RESPONSIVE TO IVF
Type 1 = Rapid / Type 2 = slow
18
Q
General beta blockers (propranolol) is used to tx what complication of cirrhosis?
A
⬇︎ GastroEsophageal variceal bleeding
19
Q
List Causes of Anion Gap Metabolic Acidosis-9
A
20
Q
List Causes of NORMAL-Anion Gap Metabolic Acidosis (NAHA)-7
A
21
Q
BUN/Cr Ratio values in
Pre
Intrinsic
Post Renal Failure
A
22
Q
UNa values in
Pre
Intrinsic
Post Renal Failure
A
23
Q
In a pt w/hematuria, what also in the urine would indicate Glomerular etx specifically?
A
Protein (On Urine Dipstick)
24
Q
How is Uremia associated w/GI px?
A
Uremia can –> Glanzmann Thromboasthenia (dysfunction of Platelet 2b3a Fibrinogen binding R) –> Bleeding! GI px and ASA avoidance is necessary to prevent GI bleeds
Dx = ⬆︎Bleeding Time // Tx = DDaVP (⬆︎release of vWF)
25
List Risk Factors for Contrast induced nephropathy; What are the 2 most important?
Ctx: **SCr \> 1.5 or GFR \<60**
26
How do you address *Contrast induced neprhopathy At-Risk pts*, who needs contrast imaging?-4
1. avoid high-concentraton radiocontrast
2. DC NSAIDs
3. [0.9% NS IVF] prior to imaging
4. NAC (*N-AcetylCysteine*) prior to imaging
27
MAJOR signs/symptoms of Uremia -6
1. AMS (FATIGUE)
2. Pericardial Rub
3. Pruritus
4. Nausea
5. Hiccups
6. Asterixis
28
List causes of PseudohypOnatremia -2
1. ⬆︎ Lipids (TAG/Chylomicrons)
2. ⬆︎ Ig
29
Major causes of [HypOtonic **Euvolemic** hypOnatremia] -7
1. SIADH (SOLC, Brain CA, Pancreatic CA, Drugs)
2. Psychogenic
3. PostOp
4. hypOthyroid
5. sick cell reset osmostat (occurs near death)
6. Beer Potomania (Beer is low in Na, high in free water)
7. Tea & Toast syndrome
30
How should you evaluate hypOnatremia?
31
How should you evaluate HYPERNatremia?
32
Normal GFR range
90 - 120 mL/min **but most labs report \> 60**
33
Normal Creatinine Clearance for Men vs Women
Men = 97-137
Women = 88-128
34
Describe the 2 types of Hepatorenal syndrome
Type 1: **Rapid & Fatal** Renal failure triggered by Spontaneous bacterial peritonitis = poor pgn
Type 2:**slow** renal decline see in refractory ascities
35
Hepatorenal Syndrome tx -4
*⬆︎volume to kidneys*
## Footnote
1st: Stop Diuretics (Spironolactone, Lasix)
2nd: IV Albumin
3rd: Alternative: Add Octreotide to vasoconstrict splanchnics
4th: Liver transplant
36
What are the 2 most common causes of Chronic Kidney Disease
DM and HTN
37
Why is a Lipid Panel ordered in CKD pts?
Prevent Cardio dz by controlling lipids **since CV dz is most common cause of Death in CKD pts**
## Footnote
*Because of this, also order EKG*
38
What is the significance of Proteinuria in CKD -2
1. Protein filtration **worsens** Kidney dz
2. Proteinuria is an indicator of early heart dz in CKD pts
39
Why is it important to prevent Hyperphosphatemia in CKD pts
Elevated Phosphate 2/2 CKD --\> ⬆︎ PTH release (*2° HyperParathyroid*) --\> [Renal Osteodystrophy] and Mortality
40
List causes of Hypertonic hypOnatremia -3
*Too much OSMOTICALLY ACTIVE substances in extracellular fluid*
1. ⬆︎ Glucose
2. ⬆︎ Glycerol
3. Mannitol
41
Wilms tumor etx
proliferation of metanephric blastema --\>
## Footnote
HAWF (Hematuria painless/HTN, Abd mass, Wt loss, Fever, Flank Pain)
42
What are the renal complications of sickle cell TRAIT - 5
1. **Painless Hematuria 2/2 papillary necrosis**
2. Inability to concentrate urine (due to vasa recta damage)
3. Distal Renal Tubular Acidosis
4. UTI
5. Renal Medullary CA
## Footnote
*Sickle cell trait is a benign condition with Hgb AS that can cause fleeting papillary necrosis*
43
UA for Acute Tubular Necrosis - 3
1. Granular cast
2. Hematuria
3. Tubular epithelial cells
44
UA for Acute interstitial nephritis
MANY Eosinophilic WBC Cast!
45
UA for Acute Glomerulonephritis
1. RBC cast with dysmorphic RBCs
2. Proteinuria
## Footnote
*These pts will also have HTN*
46
What is the earliest renal abnormality in pts diagnosed with DM?
Glomerular Hyperfiltration
## Footnote
* this is also the major pathophys mechanism for gluemrular injury in DM. Hint the reason ACE inhibitors help*
* Glomerular Hyperfiltration--\>Basement membrane thickening --\>mesangial expansion --\> Kimmelsteil Wilson nodular sclerosis*
***⬆︎ urine microalbumin:creatinine is the earliest sign of NEPHROPATHY***
47
What are the 5 different types of renal stones
1. Ca+ stones (oxalate or phosphate)
2. Uric acid radiolucent stone
3. Xanthine radiolucent stone
4. Ammonium Mg phosphate struvite
5. Cystine hexagonal stones - inherited
48
Tx for Uric acid radiolucent stone - 3
1. Alkalinize urine with [PO K+ Citrate] or NaHCO3 to \> 6.5pH
2. low purine diet
3. +/- Allopurinol
You may see uric acid radiolucent stones in tumor lysis syndrome
49
Tx for Ca+ renal stone - 4
1. Hydration ≥2L / day
2. HCTZ
3. Na+ dietary ⬇︎
4. Vit C dietary⬇︎
## Footnote
\*\*Normal Ca+ dietary intake \*\*
50
cp of Alports X-linked Syndrome - 3
*Can't **Pee**, Can't **See**, Can't **Hear** a buzzing bee*
1. isolated Hematuria AND proteinuria
2. ocular defects
3. sensorineural hearing loss
*EM = SPLITTING of Glomerular basement membrane with thinning*
51
Electron microscopy findings for Alports X-linked Syndrome
*Can't **Pee**, Can't **See**, Can't **Hear** a buzzing bee*
SPLITTING of Glomerular basement membrane with thinning
52
What type of renal effects does IV Acyclovir have? ; Tx?
Collecting Duct Crystalline nephropathy **with renal tubular obstruction**; AGGRESSIVE IVF before and after tx
53
How is Allopurinol used to prevent kidney damage during CA tx?
Allopurinol prevents **tumor lysis-associated urate crystal nephropathy** in pts receiving tx for lymphoma/leukemia
54
Needle shaped crystals on UA indicate what dx?
Uric Acid radiolucent stone
55
Normal Post Void Residual for Women
\< 150 cc
56
Normal Post Void Residual for Men
\< 50 cc
57
List the differentiating factors for a renal cyst to be classified as Simple? - 6 ; What is mngmt for Simple Renal cyst?
58
What type of cast are seen in Nephrotic Syndrome?
Fatty
59
What type of cast are seen in Chronic Renal Failure?
Waxy broad cast
60
Normal range for Ca+ is 8.4-10.4
What is the mngmt for Asymptomatic Hypercalcemia 10.4 - 14
**NOTHING**. Just avoid worsening factors like dehydration
## Footnote
**ALWAYS BE PREPARED TO GIVE IVF FOR HYPERCALCEMIA**
61
Normal range for Ca+ is 8.4-10.4
What is the mngmt for Symptomatic OR Hypercalcemia \>14 - 3
1. IVF +/- calcitonin
2. Bisphosphonates for long term
3. Avoid loop diuretics UNLESS HF is present
*Remember that Lung SQC can secrete PTH-related protein and cause Hypercalcemia*
**ALWAYS BE PREPARED TO GIVE IVF FOR HYPERCALCEMIA**
62
What are lab values that diagnose SIADH - 5
1. hypOnatremia
2. Serum Osmo \<275
3. Urine Osmo \>100
4. Urine Na+ \>40
5. low serum Uric acid
63
Causes of SIADH - 4
1. Intracranial process
2. SSRIs
3. NSAIDs
4. Lung disease in general (especially SOLC) - along with ACTH secretion
64
If renal obstruction is present, what does elevated Creatinine tell you about its laterality?
Must be **BILATERAL** - uL obstruction (i.e. from stone) does not bump creatinine since other Kidney will compensate
65
Major causes of Rhabdomyolysis - 4
1. Immobilization prolonged (direct damage)
2. Cocaine (direct damage)
3. Physical restraints
4. Dehydration
## Footnote
Muscle breakdown --\> ⬆︎CPK, ⬆︎K, ⬆︎myoglobin(which causes renal damage when filtered)
66
Which drugs cause renal tubular obstruction from Crystalline nephropathy Acute Tubular Necrosis? - 5
These crystals are like **SPAMe**!
1. **S**ulfonamides
2. **P**rotease inhbitors
3. **A**cyclovir IV
4. **M**ethotrexate
5. Ethylene Glycol
67
Why is it dangerous to give Nitroprusside to a renal failure pt? ; Tx for this?
Nitroprusside's byproduct, thiocyanate, is renal excreted, especially if infusion is \> 24 hours.
## Footnote
Tx = Sodium Thiosulfate
68
cp for Acute Urinary Retention-3 ; What are the risk factors for AUR?-6 ; Dx?
urinary retention a/w suprapubic tenderness and agitation
1. Male
2. \>80 yo
3. BPH
4. Cognitive impairment
5. Surgery
6. Meds (opioids, anticholinergics)
Dx = Bladder US ≥300cc
69
Pt has Dense Intramembranous C3 deposits in their glomerulus
Diagnosis? ; etx?
**Membranoproliferative GN type 2** (dense deposit disease); caused by IgG Ab constantly activating the alternative complement pathway
70
What are the 2 major examples of Immune complex-mediated Glomeronephritis
1. SLE
2. PSGN-PiG
71
Pt has Anti-Glomerular Basement Membrane (GBM) IgG
Diagnosis?
**G**ood**P**asture syndrome
## Footnote
**G**lomerulonephritis and **P**ulmonary hemoptysis
72
pt has Hepatitis C
What renal pathology should you be concerned for? ; cp?-3
Cryoglobulinemia
1. Palpable Purpura
2. ⬇︎complement
3. hematuria and proteinuria
HepC is also associated with Porphyria Cutanea Tarda
73
Dx criteria for Nephrotic syndrome -3
\>3g protein/24 hr + hypOalbumin + edema
74
Minimal change disease is more common in kids
When is it associated with adults? - 2
1. NSAID use
2. Hodgkin Lymphoma
75
Name the 2 most common Nephrotic syndromes in adults
FSGS \> Membranous nephropathy(subEpithelial spikes)
76
What are complement levels for IgA Nephropathy?
NML
77
Major side effects of Loop Diuretics - 4
1. ⬇︎K+ which --\>
2. metabolic alkalosis
3. Prerenal AKI
4. Tinnitus and hearing loss at high doses
78
Tx for uncomplicated cystitis - 3
PO abx **WITHOUT waiting for cx**
1. Macrobid x 5
2. Bactrim x 3
3. Fosfomycin x 1
79
Tx for complicated cystitis
## Footnote
*complicated: DM, CKD, Immunocompro, obstruction, failed initial therapy, hospital acquired, indwelling item*
**Urine CX FIRST --\> tailored abx** (or Levofloxacin PO or CefTriaxone IM while waiting for cx)
80
Which two renal pathologies is analgesic nephrophathy associated with?
1. Tubulointerstitial nephritis
2. Papillary necrosis
81
Causes of Papillary Necrosis - 5
**NSAID**
1. **N**SAIDs
2. **S**ickle Cell
3. **A**nalgesic abuse
4. **I**nfection from PYELO
5. **D**M
82
Why is Succinylcholine contraindicated in conditions like burns or skeletal muscle trauma?
Succinylcholine already causes HYPERKalemia
These conditions --\> ⬆︎PostSynpatic ACh R --\> More Succinylcholiine activity --\> FATAL HYPERKalemia
83
In a pt with pyelonephritis, cx are given before empiric abx
When is urological imaging indicated?-4
1. persistent sx after 3 days
2. hx of nephrolithiasis/obstruction
3. complicated pyelo
4. gross hematuria
84
Urine cytology is mostly helpful in diagnosing \_\_\_\_\_
Bladder CA
85
How is chronic constipation related to UTIs?
Chronic constipation can --\> rectal distension --\> compresses bladder --\> incomoplete voiding and urinary stasis --\> **RECURRENT UTIs**
86
What is a cystocele? ; cp?-3
bladder prlapse into the ANT vaginal wall --\>
1. dyspareunia
2. urinary sx
3. vaginal pressure
87
Interstitial Cystitis is also known as \_\_\_\_\_\_. Etx?
Painful Bladder Syndrome ; idiopathic chronic bladder pain **relieved with voiding**
## Footnote
*can also include dyspareunia and urinary sx. do NOT confuse with a cystocele*
88
What condition should you suspect in a PreRenal AKI that does NOT respond to IVF
HepatoRenal Syndrome
89
What are the 4 major complications of any NephrOtic syndrome
**CL****ag**
1. ⬆︎**C**oagulation from loss of AT3 (MOST COMMON WITH MEMBRANOUS NEPHROPATHY)
2. ⬆︎**L**ipidemia --\> Fat oval bodies Maltese crosses in urine
3. ⬇︎**a**lbumin
4. ⬇︎**g**ammaglobins --\> infection
90
Renal Vein Thrombosis is most commonly associated with which nephrOtic syndrome?
Membranous nephropathy
Membranous nephropathy is also the most a/w general carcinoma
91
Why do you see abnormal hemostasis in pts with chronic renal failure? ; Tx-3
CRF --\> **UREMIA** --\> Qualitative PLATELET DYSFUNCTION --\> ⬆︎Bleeding Time
Tx = DESMOPRESSIN \> Cryoprecipitate or Conjugated Estrogens
92
Why should you not give Platelet transfusion to a pt with uremic-induced abnormal hemostasis
THOSE platets will ALSO become dysfunctional and inactivated. Tx of choice = DESMOPRESSIN
93
What is the most common cause of death in Dialysis pts?
Cardiovascular disease
## Footnote
*This is also the most common COD in Renal Transplant pts*
94
Which demographic of pts are at the highest risk of Contrast induced neprhopathy? ; Px if these HAVE to be given Contrast?-2
DM pts with elevated baseline creatinine ;
1. IVF (NS or isotonic HCO3) +
2. Acetylcysteine
*This resolves in 1 week*
95
In a pt who has hypovolemic hypernatremia, which fluids should be given for resuscitation?
**NORMAL** saline first and then --\> hypOtonic saline once pt is euvolemic
96
How fast can serum sodium be corrected
0.5 mEq/dL/hr AND NO MORE THAN 12 mEq/dL/hr
97
DM pts are also at risk for NORMAL anion gap metabolic acidosis
What condition is this from?
Type 4 RTA
## Footnote
*definitely suspect this if pt has persistent hyperkalemia*
98
What type of electrolyte abnormalities are seen in chronic alcoholics? - 3
⬇︎MPK
1. ⬇︎Mg (which can --\> ⬆︎renal K+ excretion actually)
2. ⬇︎K+ (in part from the ⬇︎Mg)
3. ⬇︎Phosphorous
99
Renal stones of which size require surgical intervention?
≥5mm
## Footnote
*determined by NC upper abd helical CT*
100
Dx? ; etx?
Cystine hexagonal renal stones ; inherited amino acid transport impairment --\> **COAL** dibasic amino acids (**C**ysteine/**O**rnithine/**A**rginine/**L**ysine) accumulation
## Footnote
*will have positive urine cyanide nitroprusside test*
101
Why are pts with nephrotic syndrome at increased risk for acceleterated Atherosclerosis
**CLag**
⬆︎**L**ipidemia from loss of lipoproteins
102
What are the risk factors for Focal Segmental Glomerular Sclerosis nephrotic syndrome - 7
**HASH BPH**
1. **HIV**
2. **A**frican american
3. **S**ickle cell
4. **H**eroin
5. **B**ody builder
6. **P**arvoB19
7. **H**ispanic
103
What infections are most commonly associated with Membranoproliferative Glomerulonephritis Type 1 - 2
Hepatitis B and Hepatitis C
104
tx for Minimal Change Disease
CTS
105
What are the effects of Angiotensin II - 3
1. vasoconstrcition
2. ⬆︎Aldosterone
3. ⬆︎Na+ reabsorption DIRECTLY
106
Renal transplant dysfunction in the early post operative period has many etiologies
Name them - 5
1. Ureteral obstruction
2. Vascular obstruction
3. acute rejection (treat with IV CTS)
4. cyclosporine toxicity
5. ATN
107
What type of acid base abnormality is seen in seizure patients?
Postictal **Lactic Acidosis** after a GTC
## Footnote
this is transient and resolves within 90 min
108
When is it ok to use hypertonic 3% saline?
**symptomatic** hypOnatremia ONLY
## Footnote
*HA, NV, seizures, weakness*
109
What are the side effects of the Thiazide family - 4
Hyper**GLUC**
1. **G**lucose
2. **L**ipids
3. **U**ric acid
4. **C**alcium
110
Pt has a serum K+ of 5.7
When is it appropriate to start acute therapy (CaGluconate, Insulin with Glucose) for HyperKalemia? - 3
1. EKG changes
2. K+ ≥7
3. rapidly rising K+ from tissue breakdown
## Footnote
*ONLY give K+ lowering therapy if these are present, otherwise just fix underlying cause*
111
Normal range for Serum Osmolality
275-295
112
List the EKG changes seen in Hyperkalemia - 3
113
In which immune mediated vasculitis disorder are pts at risk for intussuception?
Bergers IgA Nephropathy Henoch Scholein Purpura
114
Which glomerular disease (nephrotic or nephritic) is most commonly associated with carcinoma?
Membranous Nephropathy
## Footnote
**BUT NOTE: MINIMAL CHANGE DISEASE IN ADULTS IS MOST ASSOCIATED WITH HODGKIN LYMPHOMA AND NSAIDS**
115
Explain Winter's Formula
COMPENSATED arterial pCO2 *should* be within +/- 2 of [1.5 x HCO3 + 8]
If not, there is a mixed picture
116
What type of acid base disturbance does TB cause? Why?
TB is a common cause of Addison's primary adrenal insufficiency which --\> ⬇︎Aldosterone --\> **Normal Anion Gap Metabolic Acidosis**
117
Explain how determining Tetanus prophylaxis works?
118
Active Hepatitis B is a huge risk factor for which glomerular disease?
Membranous Nephropathy
119
Hyalinosis of both the afferent and efferent renal arterioles indicates which disease?
Diabetic nephropathy
This process happens in **mostly the efferent** which is why DM pts first develop Glomerular Hyperfiltration
